gms | German Medical Science

Access to safe and affordable drinking water, sanitation and hygiene (WASH) for all is needed to safeguard human health. Vulnerable communities at the margins of rich societies, including people experiencing homelessness, however, are often underserved and overlooked. For them, safe WASH, and the realization of the Human Right to Water and Sanitation (HRTWS) is often no realized and shelters and public restrooms are often the only option to WASH.

Our ongoing exploratory high risk, high gain research in Bonn, Germany in collaboration with two not-for-profit homeless service organizations and decision-makers aims to i) understand challenges that people experiencing homelessness face regarding WASH insecurity, by ii) involving them as key stakeholders to co-design methods most suitable to capture the challenges they are facing, and ultimately iii) jointly identify interventions with inclusive mapping.

Co-designing methods. We test and evaluate the feasibility of methods involving people experiencing homelessness, social workers, and decision-makers, including (walking) interviews, mental mapping, photovoice, shadowing, infrastructure inspection and mapping, group discussions, arts-based research, collaborative mapping, expert interviews.

Co-defining challenges. Public water fountains, toilets, and showers are scarce, frequently unavailable, often pose safety and cleanliness issues, and access to non-public facilities may be cost-prohibitive for homeless populations. Those sleeping rough, in encampments, or shelters, are often forced to limit water consumption, forego healthy hygiene behaviours, and resort to open urination and defecation, all of which carry health risks. Extreme weather events further complicate access. Data gaps impose obstacles to improve their situation.

Co-creating solutions. People experiencing homelessness are valuable key informants. Their knowledge is vital for informing targeted health messaging and health-related interventions. They recommend numerous short-, medium- and long-term solutions to improve the situation.

Much remains to be done to serve unhoused people better with WASH, particularly in light of growing urbanization, urban poverty, increasing levels of homelessness, decreasing public investments in health-promoting infrastructure, including WASH, and climate change.